Crown Lengthening

Crown lengthening reshapes gum and bone to expose more of a tooth. It is done for two reasons. Either a tooth has broken or decayed close to the gum and a crown needs more surface to hold, or a smile shows more gum than the person wants. At Pearl32 Dentistry and Wellness in Laguna Hills, the visiting periodontist performs it in Suite 450. The final crown waits six to eight weeks while the gum line settles.

Reason one: exposing enough tooth for a crown

A crown needs a solid band of tooth to grip, usually about two millimeters above the finish line. Dentists call it the ferrule. Without it, the crown works loose or the tooth fractures under it.

The gum and bone also need room. When a filling or fracture sits at or below the gum line, the crown margin would invade the attachment, and the gum stays inflamed and bleeds indefinitely. Crown lengthening moves the gum and bone a small distance so both problems are solved at once. Then we build the crown properly.

Reason two: a gummy smile

A gummy smile often comes from teeth that never fully erupted, not from too much gum. The teeth look short because gum covers part of the enamel. Reshaping the gum and, where needed, a little bone reveals the full tooth.

We plan this with photographs, measurements and a digital scan, and we mark the proposed gum line before anything is done. Some cases are better answered by orthodontics or by a combination, and a few relate to how far the lip lifts, which gum surgery cannot change. We tell you which one you have.

What happens during the procedure?

The appointment takes about forty five to ninety minutes depending on how many teeth are involved. Local anesthetic numbs the area. The gum is lifted, a measured amount of bone is reshaped around the tooth, and the gum is repositioned at the new level and sutured.

You will feel pressure, not pain. Nitrous oxide, oral sedation and IV sedation are available, with IV sedation administered and monitored by a provider who holds the California permit for it. Soreness lasts about three to five days and responds to over the counter anti-inflammatories for most people.

Why wait six to eight weeks for the crown?

The gum line keeps moving for weeks after surgery, and a crown made too early ends with a visible margin. Six to eight weeks covers most back teeth. Front teeth, where appearance matters more, are often given three months before the final crown.

A temporary crown holds the space and the shape meanwhile. Once the tissue is stable, we take a digital scan and design the final crown, which is usually milled here in one visit. Waiting is the part people dislike and the part that decides how the margin looks in five years.

What crown lengthening will not do

It will not save every tooth. If a fracture runs below the bone, removing enough bone to expose it would undermine the tooth and its neighbors. In that case we discuss extraction and an implant instead, and we say so before you spend anything on a crown.

It will not leave the surrounding teeth untouched either. Bone has to be reshaped on the neighboring surfaces to keep the contour even, which can expose a small amount of root there. We show you where that will happen on the model. And it does not change how far your lip lifts when you smile.

What does crown lengthening cost?

Cost depends on how many teeth are treated and whether bone is reshaped, and it is quoted in writing, itemized, after an examination. The surgery and the crown that follows are quoted separately so you see the full picture before starting either one.

We are in network with most major PPO plans and Delta Dental HMO. Plans often cover crown lengthening done for a restorative reason and decline it when the reason is appearance, so we send a predetermination. Third party financing is available and the practice is not the creditor, through CareCredit, Cherry, Sunbit and Happen Bank (formerly LendingClub). See financing.

Questions people ask about crown Lengthening

Is crown lengthening the same as a gum lift?

They overlap. A gum lift usually means reshaping soft tissue only, often with a laser, and it suits cases where plenty of bone sits below the gum. Crown lengthening reshapes bone as well, which is what makes the result stable. If only soft tissue is removed where bone is close, the gum tends to grow back within months.

How long is recovery?

Most people return to work the next day. Soreness lasts three to five days and responds to over the counter anti-inflammatories. Sutures are removed or dissolve at one to two weeks. The gum keeps settling for six to eight weeks, which is why the final crown waits. Avoid hard exercise for about three days and clean the site as instructed.

Will the tooth be sensitive afterward?

Often, for a few weeks. A small amount of root is now exposed to the mouth, and root surface responds to cold. A potassium nitrate toothpaste twice a day and a fluoride varnish at your follow up visit handle most of it. Sensitivity that persists past three months is uncommon, and we investigate it rather than waiting further.

Can it be done the same day as the crown?

No, and doing so is what causes long term margin problems. The gum line needs six to eight weeks to settle, and front teeth often need three months. A temporary crown protects the tooth meanwhile and lets us test the shape. Once the tissue is stable, the final crown is scanned, designed and usually milled here in one visit.

Who performs the surgery?

The visiting periodontist who comes to our office performs crown lengthening in Suite 450, and one of our general dentists restores the tooth afterward. All three of our dentists hold a DDS from Loma Linda University. You are treated in the same office throughout, which keeps the surgical plan and the crown design connected.

This page is general information, not a diagnosis. What is right for you can only be decided after an examination.